New Nutritional and Therapeutical Strategies of NEC

2019 ◽  
Vol 15 (2) ◽  
pp. 92-105
Author(s):  
Capriati Teresa ◽  
Diamanti Antonella ◽  
de Ville de Goyet Jean
Keyword(s):  
Short Bowel Syndrome ◽  
Therapeutic Option ◽  
Severe Disease ◽  
Intestinal Resection ◽  
Systemic Complications ◽  
Short Bowel ◽  
Clinical Events ◽  
Premature Babies ◽  
Surgical Treatments

Necrotizing enterocolitis (NEC) is an acquired severe disease of the digestive system affecting mostly premature babies, possibly fatal and frequently associated to systemic complications. Because of the severity of this condition and the possible long-term consequences on the child’s development, many studies have aimed at preventing the occurrence of the primary events at the level of the bowel wall (ischemia and necrosis followed by sepsis) by modifying or manipulating the diet (breast milk versus formula) and/or the feeding pattern (time for initiation after birth, continuous versus bolus feeding, modulation of intake according clinical events). Feeding have been investigated so far in order to prevent NEC. However, currently well-established and shared clinical nutritional practices are not available in preventing NEC. Nutritional and surgical treatments of NEC are instead well defined. In selected cases surgery is a therapeutic option of NEC, requiring sometimes partial intestinal resection responsible for short bowel syndrome. In this paper we will investigate the available options for treating NEC according to the Walsh and Kliegman classification, focusing on feeding practices in managing short bowel syndrome that can complicate NEC. We will also analyze the proposed ways of preventing NEC.

S1345 Long-Term Outcome of Chronic Radiation Enteritis With Short Bowel Syndrome in a Cohort of 108 Patients, After Large Intestinal Resection

2010 ◽  
Vol 138 (5) ◽  
pp. S-233-S-234
Author(s):  
Aurelien Amiot ◽  
Francisca Joly ◽  
Jeremie H. Lefevre ◽  
Olivier Corcos ◽  
Frédéric Bretagnol ◽  
...  
Keyword(s):  
Short Bowel Syndrome ◽  
Intestinal Resection ◽  
Radiation Enteritis ◽  
Term Outcome ◽  
Long Term Outcome ◽  
Short Bowel ◽  
Chronic Radiation

S1346 Operative and Long Term Results After Large Intestinal Resection, Leading to Short Bowel Syndrome, in a Cohort of 108 Chronic Radiation Enteritis Patients

2010 ◽  
Vol 138 (5) ◽  
pp. S-234
Author(s):  
Aurelien Amiot ◽  
Jeremie H. Lefevre ◽  
Francisca Joly ◽  
Olivier Corcos ◽  
Frédéric Bretagnol ◽  
...  
Keyword(s):  
Short Bowel Syndrome ◽  
Intestinal Resection ◽  
Long Term Results ◽  
Radiation Enteritis ◽  
Short Bowel ◽  
Chronic Radiation

scholarly journals Biodistribution of the radiophamarceutical sodium pertechnetate (Na99mTcO4) after massive small bowel resection in rats

2007 ◽  
Vol 22 (6) ◽  
pp. 430-435 ◽  
Author(s):  
Dâmaso de Araújo Chacon ◽  
Irami Araújo-Filho ◽  
Arthur Villarim-Neto ◽  
Amália Cínthia Meneses Rêgo ◽  
Ítalo Medeiros Azevedo ◽  
...  
Keyword(s):  
Small Intestine ◽  
Short Bowel Syndrome ◽  
Intestinal Mucosa ◽  
Intestinal Resection ◽  
Small Bowel Resection ◽  
Control Group ◽  
Short Bowel ◽  
Massive Resection ◽  
Mucosal Thickness ◽  
Misleading Interpretation

PURPOSE: To evaluate the biodistribution of sodium pertecnetate (Na99mTcO4) in organs and tissues, the morphometry of remnant intestinal mucosa and ponderal evolution in rats subjected to massive resection of the small intestine. METHODS: Twenty-one Wistar rats were randomly divided into three groups of 7 animals each. The short bowel (SB) group was subjected to massive resection of the small intestine; the control group (C) rats were not operated on, and soft intestinal handling was performed in sham rats. The animals were weighed weekly. On the 30th postoperative day, 0.l mL of Na99mTcO4, with mean activity of 0.66 MBq was injected intravenously into the orbital plexus. After 30 minutes, the rats were killed with an overdose of anesthetic, and fragments of the liver, spleen, pancreas, stomach, duodenum, small intestine, thyroid, lung, heart, kidney, bladder, muscle, femur and brain were harvested. The biopsies were washed with 0.9% NaCl.,The radioactivity was counted using Gama Counter WizardTM 1470, PerkinElmer. The percentage of radioactivity per gram of tissue (%ATI/g) was calculated. Biopsies of the remaining jejunum were analysed by HE staining to obtain mucosal thickness. Analysis of variance (ANOVA) and the Tukey test for multiple comparisons were used, considering p<0.05 as significant. RESULTS: There were no significant differences in %ATI/g of the Na99mTcO4 in the organs of the groups studied (p>0.05). An increase in the weight of the SB rats was observed after the second postoperative week. The jejunal mucosal thickness of the SB rats was significantly greater than that of C and sham rats (p<0.05). CONCLUSION: In rats with experimentally-produced short bowel syndrome, an adaptive response by the intestinal mucosa reduced weight loss. The biodistribution of Na99mTcO4 was not affected by massive intestinal resection, suggesting that short bowel syndrome is not the cause of misleading interpretation, if an examination using this radiopharmaceutical is indicated.

scholarly journals Incidence and Outcomes of Home Parenteral Nutrition in Patients With Crohn Disease in Olmsted County, Minnesota

2020 ◽  
Vol 2 (4) ◽  
Author(s):  
Zeinab Bakhshi ◽  
Siddhant Yadav ◽  
Bradley R Salonen ◽  
Sara L Bonnes ◽  
Jithinraj Edakkanambeth Varayil ◽  
...  
Keyword(s):  
Weight Loss ◽  
Parenteral Nutrition ◽  
Short Bowel Syndrome ◽  
Crohn Disease ◽  
Severe Disease ◽  
Bloodstream Infections ◽  
Home Parenteral Nutrition ◽  
Average Weight ◽  
Olmsted County ◽  
Short Bowel

Abstract Background We sought to estimate the incidence of home parenteral nutrition (HPN) use in a population-based cohort of patients with Crohn disease (CD), and to assess clinical outcomes and complications associated with HPN. Methods We used the Rochester Epidemiology Project (REP) to identify residents of Olmsted County, who were diagnosed with CD between 1970 and 2011, and required HPN. Results Fourteen out of 429 patients (3.3%) with CD received HPN (86% female). Eleven patients (79%) had moderate–severe CD and 12 patients (86%) had fistulizing disease. Thirteen patients (93%) underwent surgery, primarily due to obstruction. Among CD incidence cases, the cumulative incidence of HPN from the date of CD diagnosis was 0% at 1 year, 0.5% at 5 years, 0.8% at 10 years, and 2.4% at 20 years. Indications for HPN included short bowel syndrome in 64%, malnutrition in 29%, and bowel rest in 21%. The median duration of HPN was 2.5 years. There was an average weight gain of 1.2 kg at 6 months, an average weight loss of 1.4 kg at 1 year, and a further weight loss of 2.2 kg at 2 years from the start of HPN. Patients were hospitalized a mean of 5 times after the start of HPN, mainly due to catheter-related bloodstream infections and thrombosis. Conclusions Less than 4% of patients with CD need HPN. Most have moderate to severe disease with short bowel syndrome or malnutrition. Possible reasons for the patients’ weight loss could be noncompliance, and increased metabolic needs because of active disease.

Long-Term Outcome of Children with Short Bowel Syndrome Treated with a Modification of the STEP Technique Avoiding Mesenteric Defect

2021 ◽  
Author(s):  
Javier Bueno ◽  
Laura García-Martínez ◽  
Susana Redecillas ◽  
Oscar Segarra ◽  
Manuel López
Keyword(s):  
Short Bowel Syndrome ◽  
Bacterial Overgrowth ◽  
Central Line ◽  
Term Outcome ◽  
Long Term Outcome ◽  
Short Bowel ◽  
Mesenteric Defects ◽  
Multiple Ulcers

Abstract Background The Serial Transverse Enteroplasty Procedure (STEP) Registry has reported a 47% success to achieve enteral autonomy in pediatric short bowel syndrome (SBS). We have performed the STEP with a technical modification (MSTEP) consisting in stapler application without mesenteric defects that can also be applied to the duodenum. Our experience with this technique is described. Materials and Methods In this study, 16 children with SBS underwent MSTEP (2005–2019). Indications were nutritional autonomy achievement (n = 11, with duodenal lengthening in 5/11) and bacterial overgrowth treatment (n = 5). Results With a median follow-up of 5.8 years (0.7–13.7 years), 5 of 11 (45%) patients achieved enteral autonomy, 4 of them with duodenal lengthening. Four of four who preserved > 50% colon, while only one of seven with < 50% of colon achieved enteral autonomy (p < 0.05). After redo procedures, three of four attained enteral autonomy. Thus, 8 of 11 (73%) progressed to enteral autonomy, including all with duodenal lengthening. One child, already parenteral nutrition free, died due to central line sepsis. All the patients from the bacterial translocation group improved their metabolic/nutritional status, but one required subsequent enterectomy of the lengthened intestine due to multiple ulcers in the staple lines. Conclusion The effectiveness of MSTEP to achieve enteral autonomy seems similar to the classical STEP. It can be applied to the duodenum. The retained colon length may influence the post-STEP enteral autonomy achievement.

The impact of intestinal resection on the immune function of short bowel syndrome patients

2016 ◽  
Vol 77 (12) ◽  
pp. 1202-1208 ◽  
Author(s):  
Walter Miguel Turato ◽  
Helioswilton Sales-Campos ◽  
Camila Bitu Moreno Braga ◽  
Selma Freire Carvalho Cunha ◽  
José Henrique Silvah ◽  
...  
Keyword(s):  
Immune Function ◽  
Short Bowel Syndrome ◽  
Intestinal Resection ◽  
Short Bowel ◽  
The Impact

scholarly journals Clinical case and short review of extreme short bowel syndrome: an update 21 years after

2016 ◽  
Vol 10 (1) ◽  
pp. 45
Author(s):  
Pasquale Mansueto ◽  
Aurelio Seidita ◽  
Salvatore Iacono ◽  
Antonio Carroccio
Keyword(s):  
Small Intestine ◽  
Short Bowel Syndrome ◽  
Clinical Case ◽  
Ileocecal Valve ◽  
Short Review ◽  
Short Bowel ◽  
Massive Resection ◽  
Low Weight ◽  
Clinical Conditions

Short bowel syndrome refers to the malabsorptive state caused by loss of significant portions of the small intestine, whose clinical framework is characterized by malnutrition, diarrhea, dehydration, weight loss, and low-weight-related symptoms/signs. These clinical conditions seem to be related to the length of resection. Twenty-one years ago we reported the clinical case of an infant, who underwent a massive resection of the loops of the small intestine, of the cecum and of part of the ascending colon, due to intestinal malrotation with volvulus. The residual small intestine measured just 11 cm and consisted of the duodenum and a small part of jejunum, in the absence of the ileocecal valve, configuring the case of a <em>ultra-short bowel syndrome</em>. In this report, we update the case, reporting the patient succeeded to obtain a good weight gain and to conduct a quite normal lifestyle, despite the long-term consequences of such resection.

Short Bowel Syndrome

2015 ◽  
Author(s):  
Robert Burakoff ◽  
Alison Goldin
Keyword(s):  
Small Intestine ◽  
Short Bowel Syndrome ◽  
Average Length ◽  
Intestinal Failure ◽  
Clinical Manifestations ◽  
Intestinal Resection ◽  
Intestinal Atresia ◽  
Congenital Defects ◽  
Short Bowel ◽  
Vascular Insufficiency

Short bowel syndrome (SBS) is a state of malabsorption resulting from physical or functional loss of large portions of the small intestine, and is the most common cause of intestinal failure. The average length of a human’s small intestine is between 3 and 8 m, depending on the type of measurements made (surgical, radiologic, or autopsy); SBS occurs when less than 200 cm of small bowel remains. SBS may be congenital (intestinal atresia) or acquired. Physical losses usually occur from surgical resection for Crohn disease (CD), vascular insufficiency, radiation, malignancy, trauma, or volvulus. The site of intestinal resection helps to determine the degree of intestinal capacity. Functional losses, on the other hand, are less common and occur in the setting of a nonfunctioning, but intact, small intestine. Examples include radiation enteritis, congenital defects, and inflammatory bowel disease (IBD). This review addresses the epidemiology, pathophysiology and pathogenesis, clinical manifestations, treatment, complications, and prognosis of SBS. A figure shows sites of intestinal nutrient absorption. A table lists potential complications of SBS in patients receiving parenteral nutrition (PN). This review contains 1 highly rendered figure, 1 table, and 67 references. 

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